Provider Demographics
NPI:1104172832
Name:BRANT HOLBROOK, LSA, PLLC
Entity type:Organization
Organization Name:BRANT HOLBROOK, LSA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:BRANT
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:512-973-9222
Mailing Address - Street 1:1822 W BRAKER LN #81603
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-3606
Mailing Address - Country:US
Mailing Address - Phone:512-973-9222
Mailing Address - Fax:512-777-4527
Practice Address - Street 1:1822 W BRAKER LN #81603
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-3606
Practice Address - Country:US
Practice Address - Phone:512-973-9222
Practice Address - Fax:512-777-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00042246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty